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Rashnoo F, Farsad SM, Pejhan S, Faz AA, Mirhashemi SH, Soori M, Oshidari B, Nasrollah EH, Hakakzadeh A, Peyvandi H. A Prospective Study Comparing Treatment Outcomes Of Empyema Management Techniques: Chest Tube Vs. Video-Assisted Thoracoscopic Surgery. RUSSIAN OPEN MEDICAL JOURNAL 2022. [DOI: 10.15275/rusomj.2022.0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction — High mortality and morbidity rate of empyema, despite effective antibiotic therapy, highlights the need to determine the optimal drainage method as a first-line surgical intervention. Controversies behind the treatment choice for empyema encouraged us to conduct this study aimed at demonstrating efficacy and differences of two techniques of clinical approach to empyema, chest tube and video-assisted thoracoscopic surgery (VATS) with respect to outcomes. Material and Methods — We recruited 60 eligible patients with empyema and distributed them among two groups according to applied treatment strategies, either chest tube treatment method (Group I, 30 subjects) or VATS (Group II, 30 patients). Data were statistically analyzed by SPSS software, version 19. Then, the one-sample Kolmogorov–Smirnov test confirmed the normality of data distribution, and independent samples t-test was performed. Statistical significance was assumed at p<0.05. Results — We established that the length of hospital stay (p=0.002), the need for second intervention (p<0.001), and rate of recurrence (readmission) (p=0.001) were significantly lower in patients treated with VATS, compared with patients who were subjected to chest tube drainage. Additionally, patients who underwent VATS exhibited higher satisfaction level (p=0.03) and improved clinical condition at the time of discharge (discharged without chest tube) (p<0.001), than those from Group I. Radiographic examination on postoperative day 7 revealed a higher rate of complete cure (normal lung expansion) in the VATS group (p=0.004). Conclusion — According to the results of our study, VATS is a better treatment technique of empyema, compared with chest tube.
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Affiliation(s)
| | | | - Saviz Pejhan
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | - Mohsen Soori
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | | | - Hassan Peyvandi
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Nishida T, Igarashi Y, Suno Y, Murata T, Miyake K, Isogai N, Shimoyama R, Kawachi J, Kashiwagi H, Tsukiyama T, Fukai R. Multimodal treatment for acute empyema based on the patient's condition, including patients who are bedridden: A single center retrospective study. CANADIAN JOURNAL OF RESPIRATORY THERAPY : CJRT = REVUE CANADIENNE DE LA THERAPIE RESPIRATOIRE : RCTR 2021; 57:143-146. [PMID: 34761101 PMCID: PMC8527924 DOI: 10.29390/cjrt-2021-032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The incidence of acute empyema has increased in various countries; some elderly patients with acute empyema have contraindications for surgery under general anesthesia. Therefore, suitable management based on a patient's clinical condition is required. Methods We evaluated the different surgical and nonsurgical therapeutic approaches available for patients with acute empyema. This was a retrospective study of 57 patients with acute empyema who received treatment in our department between May 2015 and February 2019. For patients who did not initially improve with drainage or drainage combined with fibrinolytic therapy, surgery, or additional percutaneous drainage was performed based on their general condition. We compared several clinical factors pertaining to the patients who underwent surgical versus nonsurgical treatment. Results Our study showed that the patients with a performance status of 0-2 and an American Society of Anesthesiologists physical status classification of class II or lower underwent surgery safely without major operative complications. The combination of repeated drainage of the pleural cavity and fibrinolytic therapy appeared to be a reasonable nonsurgical management option for patients in poor overall condition. Conclusion For an aging population, we think that the combination of repeated pleural cavity drainage procedures and fibrinolytic therapy is a reasonable nonsurgical strategy for the management of patients with acute empyema.
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Affiliation(s)
- Tomoki Nishida
- Department of General Thoracic Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Yuto Igarashi
- Department of General Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Yuma Suno
- Department of General Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Takaaki Murata
- Department of General Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Katsunori Miyake
- Department of General Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Naoko Isogai
- Department of General Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Rai Shimoyama
- Department of General Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Jun Kawachi
- Department of General Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Hiroyuki Kashiwagi
- Department of General Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Toshitaka Tsukiyama
- Department of Interventional Radiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Ryuta Fukai
- Department of General Thoracic Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
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Abd Karim SH, Wan Zain WZ, Mohd Hashim MN, Zakaria AD, Hayati F, Ng CY. Empyema thoracis presented as giant back abscess. Radiol Case Rep 2021; 16:1061-1064. [PMID: 33680277 PMCID: PMC7917453 DOI: 10.1016/j.radcr.2021.02.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 12/15/2022] Open
Abstract
Empyema thoracis (ET) is defined as pus in the pleural space, either localized or involving the entire pleural cavity, due to diverse etiologies. In severe form, it may infiltrate the extrapulmonary region. Clinical guideline describes 3 stages of parapneumonic effusion before developing into an ET, namely the exudative stage, the fibrinopurulent stage, and the organizing/late stage. We highlight a 59-year-old gentleman who presented a back swelling masquerading as a deep-seated abscess, in which the diagnosis of ET had not been established early. The principles of treatment are treating the underlying condition such as pneumonia, pleural drainage and debridement, full re-expansion of the collapsed lung by performing chest physiotherapy, and improving nutrition. ET is a condition with a dynamic process due to diverse etiologies, either localized or involving the entire pleural cavity. The gold standard in diagnosing ET is the pleural aspiration of fluid from the pleural space, whereas the management of ET may include non-surgical and/or surgical treatments based on the basic principles of ET treatment.
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Affiliation(s)
- Siti Hafzan Abd Karim
- Department of General Surgery, Hospital Universiti Sains Malaysia, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Wan Zainira Wan Zain
- Department of General Surgery, Hospital Universiti Sains Malaysia, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Mohd Nizam Mohd Hashim
- Department of General Surgery, Hospital Universiti Sains Malaysia, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Andee Dzulkarnaen Zakaria
- Department of General Surgery, Hospital Universiti Sains Malaysia, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Firdaus Hayati
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Chiak Yot Ng
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
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Iqbal N, Ammar M, Irfan M, Jabeen K. Trichosporon Species and Fusarium Species as a Cause of Empyema Thoracis in a Diabetic Patient. Cureus 2020; 12:e8973. [PMID: 32775055 PMCID: PMC7402428 DOI: 10.7759/cureus.8973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Of late, fungal infections are increasingly being recognized in diabetic patients. Here we present a case of polymicrobial fungal empyema due to Trichosporon species and Fusarium species developed after community-acquired pneumonia in a diabetic patient. Trichosporon species are basidiomycetous yeast and Fusarium species are soil saprophytes with a worldwide distribution. Fungal empyema cases are rare and are mostly caused by Aspergillus and Candida species. Polymicrobial fungal empyema with Trichosporon species and Fusarium species has not been reported previously. Our patient was successfully treated with antifungal therapy. This case highlights that fungal empyema should be considered in diabetic patients especially if they are not responding to antibiotics.
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Affiliation(s)
- Nousheen Iqbal
- Section of Pulmonary and Critical Care Medicine, Aga Khan University, Karachi, PAK.,Medicine / Pulmnonology, Jinnah Medical and Dental College, Karachi, PAK
| | - Muhammad Ammar
- Internal Medicine, Dow International Medical College, Karachi, PAK.,Section of Pulmonary and Critical Care Medicine, Aga Khan University, Karachi, PAK
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Nandan D, Agarwal S, Bidhuri N, Shrivastava K, Nanda P, Lata S. Role of Intrapleural Urokinase in Empyema Thoracis. Indian J Pediatr 2019; 86:1099-1104. [PMID: 31628638 DOI: 10.1007/s12098-019-03060-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 08/06/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To study the role of fibrinolytic therapy in pediatric empyema in relation to duration of hospital stay, need for surgical intervention and survival to discharge. METHODS Retrospective analysis of case records of children <16 y of age admitted in a tertiary care hospital during January 2013 - December 2017 with diagnosis as empyema thoracis was done. Clinico-laboratory characteristics and the primary and secondary outcomes between the group which received intrapleural urokinase (IPU) and the group which did not (non IPU), were compared. RESULTS Of the 84 cases, 40 children received IPU. Mean duration of hospital stay in IPU group (17.51 + 4.57 d) was significantly less than non IPU group (24.32 + 10.18 d, CI -10.19 to -3.64, p < 0.001), so was the duration of intercostal drain (ICD) insertion (9.08 + 3.12 d - IPU group vs. 11.20 + 3.95 d - non IPU group, CI -3.68 to -0.50, p < 0.01). No statistically significant difference was found between the groups with regard to need for surgical intervention [IPU - 4 (10%), non IPU - 9 (20.4%), p = 0.23]. There was no mortality or adverse reaction to urokinase in either group. CONCLUSIONS IPU holds promising results in terms of reduction of hospital stay and duration of ICD insertion. It may be the initial choice of treatment in septated empyema where surgical options are not easily available or cost-effective especially in resource limited settings.
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Affiliation(s)
- Devki Nandan
- Department of Pediatrics, PGIMER and Dr. RML Hospital, Delhi, India
| | - Sheetal Agarwal
- Department of Pediatrics, PGIMER and Dr. RML Hospital, Delhi, India.
| | - Neha Bidhuri
- Department of Pediatrics, PGIMER and Dr. RML Hospital, Delhi, India
| | | | - Pamali Nanda
- Department of Pediatrics, PGIMER and Dr. RML Hospital, Delhi, India
| | - Sandhya Lata
- Department of Pediatrics, PGIMER and Dr. RML Hospital, Delhi, India
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